Quality statement 4: Assessment for cervical spine injury

Quality statement 4: Assessment for cervical spine injury

Quality statement

People with full in-line spinal immobilisation have their risk of cervical spine injury assessed using the Canadian C‑spine rule.

Rationale

If a person might have a spinal injury, it is important to immobilise their spine during assessment to prevent any damage. However, continuing immobilisation for longer than necessary can lead to avoidable adverse effects, such as discomfort and skin breakdown. Using a risk assessment tool as soon as possible to determine whether to carry out, maintain or remove immobilisation will reduce the risk of spinal cord injury and minimise discomfort for the person. It will also help to determine whether further investigations, such as prompt imaging, are needed.

Quality measures

Structure

Evidence of the documented use of checklists to ensure that the Canadian C‑spine rule is used to assess people with full in‑line spinal immobilisation for their risk of cervical spine injury.

Data source: Local data collection, for example service specifications.

Process

Proportion of people with full in‑line spinal immobilisation who have had their risk of cervical spine injury assessed using the Canadian C‑spine rule.

Numerator – the number in the denominator who have had their risk of cervical spine injury assessed using the Canadian C‑spine rule.

Denominator – the number of people with full in‑line spinal immobilisation.

Outcomes

b) Rates of appropriate removal of full in-line spinal immobilisation.

Data source:Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (ambulance services, major trauma centres, trauma units and district general hospitals) train staff in using the Canadian C‑spine rule and implement its use in pre‑hospital and hospital settings to carry out risk assessment for cervical spine injury for people with full in‑line spinal immobilisation.

Healthcare professionals (paramedics and trauma teams) use the Canadian C‑spine rule to carry out risk assessment for people with full in‑line spinal immobilisation, and document this. A digital reference tool that contains the Canadian C‑spine rule, such as MDCalc, can be used when doing the assessment. The level of risk of cervical spine injury should be used to make decisions on whether spinal immobilisation and prompt imaging are needed.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that have checklists to document the use of the Canadian C‑spine rule to assess the risk of cervical spine injury for people with full in‑line spinal immobilisation, and inform decisions about when to carry out or continue with spinal immobilisation and request prompt imaging.

People with a possible spinal injury who have their spine immobilised to prevent further injury, using a special collar and head supports, are asked questions by the ambulance team to try to find out how likely it is that they have a spinal injury, and which part of the spine might be injured. These questions include their age, the type of injury they have had and how they became injured. The same questions are asked again when the person arrives at the hospital. If the hospital staff think the person might have a spinal injury, they offer a scan. If the spine is unlikely to be injured, hospital staff remove the collar and head supports.